1972795508 NPI number — DR. BARBARA MARY EBEL MD

Table of content: DR. BARBARA MARY EBEL MD (NPI 1972795508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972795508 NPI number — DR. BARBARA MARY EBEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBEL
Provider First Name:
BARBARA
Provider Middle Name:
MARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TALWAR
Provider Other First Name:
BARBARA
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972795508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4435 GULF BREEZE PARKWAY
Provider Second Line Business Mailing Address:
GOOD SAMARITAN CLINIC
Provider Business Mailing Address City Name:
GULF BREEZE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-934-0064
Provider Business Mailing Address Fax Number:
850-934-7839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4435 GULF BREEZE PARKWAY
Provider Second Line Business Practice Location Address:
GOOD SAMARITAN CLINIC
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-934-0064
Provider Business Practice Location Address Fax Number:
850-934-7839
Provider Enumeration Date:
08/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME 68728 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: ME 68728 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)